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June 9, 2021

A renowned surgeon almost died from Covid-19. Here's what he learned facing 'the reality of death.'

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Jun 1, 2022.

    In March 2020, Tomoaki Kato, surgical director of adult and pediatric liver and intestinal transplantation at NewYork-Presbyterian/Columbia University Irving Medical Center and seven-time marathoner, nearly died from Covid-19—an ordeal that has transformed how he interacts with his patients, Denise Grady reports for the New York Times.

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    'I thought I was going to be fine'

    At age 56, Kato was exceptionally fit, Grady reports. He had run the New York City Marathon seven times, and he specialized in operations that often lasted between 12 and 20 hours. "I never got sick," Kato said. "I had never faced the reality of death."

    Because he was generally healthy, Kato at first dismissed the bad backache and intermittent fevers he got in March 2020. Kato decided to stay home for a few days and monitor his oxygen levels, which read around 93 and 94%, Grady reports—readings that later in the pandemic, health care professionals would recognize as a possible sign of Covid pneumonia.

    "I think that fooled us for a few days while he was at home," Marcus Pereira, medical director of the hospital's infectious disease program for transplant recipients, who oversaw Kato's care while he was hospitalized, said. "His oxygen levels were a little low, but he said, 'I feel fine,' and his heart rate was not that fast. He was one of the first-wave patients, and we were still learning about Covid."

    Then, one morning in the shower, Kato couldn't breathe. He started violently coughing, Grady reports. When he was finally able to take his oxygen levels, they were dangerously low—below 90%.

    "That's when I decided to check into the hospital," Kato said.

    'An eye-opening moment'

    "When we actually saw him in the hospital, it was an eye-opening moment," Pereira said. "He looked very sick from the moment he got here, and you realize, this potentially might not end up well. It was a very shocking moment. His oxygen levels were very low, he was breathing very rapidly, his heart rate was going very fast, his chest X-ray looked like he had severe Covid."

    Kato was placed on a ventilator the following day, and from there, his condition continued to deteriorate, Grady writes; he acquired bacterial infections and sepsis, and was eventually placed on dialysis. When his lungs were no longer strong enough to use the ventilator, he was connected to an ECMO machine that pumped oxygen directly into his blood and removed the carbon dioxide.

    "When someone is on ECMO, you're suddenly into the absolute highest-mortality group," Pereira said. "Your chances of coming back from that are in the single digits. When he went on that, it was sort of a moment. We all felt we were about to lose him."

    Kato spent a month on a ventilator and a week on the ECMO machine before he was able to breathe on his own, Grady reports. But even after he was off the machines and regained full consciousness, Kato wasn't himself—he suffered from ongoing delusions. "I wasn't making sense," Kato said.

    "Once we got over, 'Would he survive?' in our minds was, 'Will he be able to be a doctor again?'" Jean Emond, chief of transplant services at the hospital, said. "He suffered. He paid a huge price."

    Scans revealed a blood clot and hemorrhage in Kato's brain that fortunately were minor, and Kato felt as though he had mentally recovered about a week after he came off the ventilator, Grady reports. The physical recovery took longer, however, and it wasn't until August 2020 that he was able to return to work.

    A new perspective on interacting with patients

    When Kato started performing surgeries again, "[i]t was a really big day for everybody," Emond said. And from there, Kato said, he felt he was back to "full speed," completing 70 surgeries, including 40 transplants by March of this year.

    However, Kato said that although he has recovered, his battle with Covid-19 has changed how he interacts with patients. "I really never understood well enough how patients feel," he said. "Even though I'm convincing patients to take a feeding tube, and encouraging them, saying, 'Even though it looks like hell now, it will get better and you'll get through it,' I really never understood what that hell means."

    "I can be much more on their side, in their shoes, in their thinking," Kato said. "'I was there' are very powerful words for patients," he added.

    For example, when Kato was taken off his ventilator, he wasn't able to speak at first. "I learned that when you cannot talk, it does not mean you are not thinking," he said. "The mind is so clear."

    Kato also said that his illness gave him a renewed perspective on his career and goals. "You don't really want to waste your time, because you never know—one day all of a sudden you are in this situation," he said (Grady, New York Times, 6/4).

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